Establishing an endoscopy unit for management of Schistosoma mansoni hepatosplenic morbidities in North-Western Tanzania

Background: In Tanzania, hepatosplenic schistosomiasis (HSS) is a common cause of morbidity and mortality among adult patients. However, capacity to manage HSS is very low. Here we report learning experience, capacity building and collaborative partnership in establishing a functional gastrointestinal endoscopy unit. Methods: A need assessment for a gastrointestinal endoscopy unit at Nansio District Hospital was conducted. The findings highlighted a clear need for establishing the endoscopy unit, given the burden of HSS and its associated mortality and lack of skilled human resources. Key priorities included capacity building for human resources, renovation of the building, provision of scholarships for resident in internal medicine, establishment of an HSS patient registry and clinic, and strengthening of ultrasound services. Results: The gastrointestinal endoscopy unit commenced operations in August 2023. To date, a total of 666 patients have been attended (442 [66.4%] male and 224 [33.6%] female). Abdominal distension (66%), hematemesis (41%), and melena (41%) were common symptoms. Ultrasound examination revealed periportal fibrosis (PPF) in 71.5% of patients and liver image patterns C–F in 80.4%, both correlating with the severity of PPF. Of the 666 patients, 560 underwent endoscopic examination and the common diagnosis was grade IV esophageal varices (52.1%). Among these, 84% underwent variceal ligation. On follow-up, 90% of patients achieved variceal eradication. Conclusion: The establishment of the GI endoscopy unit at the district hospital in rural Tanzania was possible through the support of different stakeholders.